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This webinar focuses on low-income, uninsured Working-age Adults in Oklahoma andthe challenges they face in accessing dental care.In this overview I’ll quantify the scope of the problem and define the oral healthsafety net that works to address it.After that, you’ll hear directly from some of the organizations who are a part of thesafety net and how they help their patients or clients. At that time, I’ll also report onthe experience our Foundation has gained by conducting the COVID-19 PandemicDental Emergency Response Program since April 2020.The goal is for you to gain some fresh insight and ideas for how you can serve yourconstituents or collaborate with other organizations to expand your reach.1
There is not a great deal of Oklahoma-specific research available but here is what weknow about working-age adults in the U.S. –As a whole, regardless of income and race, adults ages 19-64 have the highest rate ofuntreated dental decay of any age group at an overall rate of 26.6%.There is significant disparity correlated to race, but that is another webinar!Source: CDC, National Center for Health Statistics Data Brief No. 197, May 20152
The lack of access to dental care greatly impacts working-age adults.18% of low-income Oklahomans self-report having poor oral health and 40% reportavoiding smiling due to the condition of their mouth.3
One of the indicators on our own 2020 Oklahoma Oral Health Report Card measuredthe % of working-age adults who visited a dentist in the past year. The Report Cardused the most recent CDC data available at the time (data year 2016) and we scored aD in relation to the rest of the nation.The CDC recently released 2018 data, and I’m very pleased to say that we improvedto a C for this indicator! (I have a feeling all that ground was lost in 2020. But we’lltake the win for now!)Source: https://www.cdc.gov/oralhealthdata/index.html4
Untreated dental decay is particularly damaging when it shows. Some would say poordental appearance is the last tolerated form of classism in the U.S., and perhaps nosegment of the population is impacted by this aspect more than working age adults.Dental appearance is a powerful sign of socioeconomic status and research indicatesthat visibly poor oral health negatively affects self-esteem and employability -- and isself-perpetuating.For example, Bob has missing and decayed front teeth because he doesn’t have agood-paying job with dental benefits. And he doesn’t have a good-paying job withbenefits because he has missing and decayed front teeth.5
Cost may be the most obvious barrier to dental care, but it’s certainly not the onlybarrier.Other barriers include : The inability to take time off from work or the wages lost when they do; Access to a dentist – either geographical or availability of appointments, especiallyin regard to Soonercare providers; Transportation; Childcare or other responsibilities also interfere with this group’s ability to visit adentist.6
The Oral Health Safety Net exists to help meet the needs of people unable to accessdental care on their own through the private practice sector.The safety net is not a formal, organized system, but instead a collection of highlydiverse components:Medicaid/Medicare, Hospital ED, Low-cost clinics, Free clinics & programs.Dr. Luce will discuss SoonerCare, Oklahoma’s Medicaid program next.Hospital Emergency Departments are a de facto component of the safety net, butfrankly should not be. I’ll talk more about that later when I present findings from ourpandemic ED diversion program.7
Examples of low-cost dental clinics include:Federally Qualified Health Centers (FQHCs) – also known as Community HealthCenters (CHCs) – which are 501(c)3, nonprofit dental clinics with sliding fees scales.Non-FQHC nonprofit clinics, like NSO Dental Clinic in OKC, andAcademic Dental Institutions: OU College of Dentistry and dental hygiene programs – which provide reduced-feequality care & indigent care funds. Dental Hygiene Programs such as those at Rose State College and Tulsa CommunityCollege.8
Charitable mobile and portable dentistry components of the oral health safety netutilize volunteer dentists and include programs like: MobileSmiles Oklahoma, a program of Oklahoma Dental Foundation Oklahoma Mission of Mercy, a partnership program of Oklahoma DentalAssociation, Oklahoma Dental Foundation and Delta Dental of OklahomaFoundation Remote Area Medical (RAM) Oklahoma, a program of the Oklahoma Rural HealthNetworkThere are also mobile units operated by Community Health Centers and Tribes.9
Numerous free dental clinics deliver direct care throughout the state year round.Generally, the need for services far exceeds the capacity of these clinics.10
Volunteer Care Facilitation has been around for more than 20 years. D-DENT(Dentists for the Disabled and Elderly in Need of Care) and EODDS (Eastern OklahomaDonated Dental Services) are administrative programs that recruit and maintain aroster of dentists who volunteer to treat one or more patients per year in their ownprivate practices. D-DENT and EODDS process the applications and match the patientsto volunteer dentists. The programs provide comprehensive dentistry, includingdentures. But there is generally a significant wait list for these services.11
Compensated Care Facilitation is a newer concept, that was born from the need toexpand capacity beyond what volunteer dentists alone can provide. In this model,Delta Dental of Oklahoma Foundation provides a grant to an organization that isalready providing wrap-around services to a particular population. The organizationuses this Compensated Care Fund to pay for dental care either through one of thelow-cost dental clinics I mentioned earlier, or though a private practice dentist who iswilling to deliver the care at Medicaid rates.12
Let’s talk about output in 2019, the 27 free clinics and programs I just mentionedserved 12,762 adults over age 19. The value of the care delivered was more than 10million! That’s awesome!To clarify: this is the capacity of the free clinics and programs only. The low-costclinics have their own capacity.13
Now, let’s look at the scope of the need .Just over a million working-age adults in Oklahoma are dentally uninsured.Now, theoretically, just because you don’t have dental insurance doesn’t mean youcan’t afford dental care, right?So, let’s look at income now (Note: These figures are pre-Pandemic and regional. The number of dentally uninsured individuals inOklahoma is likely oducts/databriefs/db336.htm14
About 15% of working-age adults in Oklahoma– that’s about 360,000 – live at orbelow the poverty level.Just to be nice, we’ll exclude the SoonerCare adults from that figure. I say thatbecause – spoiler alert – Soonercare currently only covers extractions. That meansSoonerCare adults need safety net resources for all other care. But I’ll let Dr. Luceelaborate on that! Even if you assume 227,000 SoonerCare adults are getting thedental care they need, we still have 132,130 adults at the poverty level.Keep in mind, the poverty level is just 12,760 for an individual and 26,200 for afamily of four. Even if an individual is living at 200% of the poverty level – making 25,520 – cost is still going to be a huge barrier to care. Can we agree on that?Unfortunately, 808,616 working-age adults in Oklahoma are living under 200% of theFederal Poverty Level. If you exclude SoonerCare adults, we still have 581,073working-age adults who most likely cannot afford dental care.Remember that number of adults served by all those free dental clinics & programsin 2019?12,762 vs. 581,073That’s quite a gulf. Now, to be clear, free dental programs are not the answer. Theyare the last resort. One key is to help patients afford their own care at low-costclinics. Another possible key is SoonerCare expansion.15
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Non-FQHC nonprofit clinics, like NSO Dental Clinic in OKC, and Academic Dental Institutions: OU College of Dentistry and dental hygiene programs –which provide reduced-fee quality care & indigent care funds. Dental Hygiene Programs such as those at Rose State College and Tulsa Community College. 8. Charitable mobile and portable dentistrycomponents of the oral health safety net .